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General NPI Number Information
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NPI Number | 1679586200
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Entity Type | Individual
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Provider Name | BRINDA GNANASHANMUGAM M.D
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 514 E GRACE ST
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City | PUNTA GORDA
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State | FL
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Zip | 33950-6121
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Country | US
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Telephone | 941-833-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 121 GRAHAM ST SW
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-9122
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Country | US
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Telephone | 941-743-4386
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Fax | 941-743-4386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME39459
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License Number State | FL
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